NR-293 Pharmacology for Nursing Practice - Set 2 - Part 2

Correct Answer: Conversion of angiotensin one to angiotensin two

The converting enzyme turns angiotensin one into angiotensin two, and blocking it removes the vasoconstriction, aldosterone release, and remodeling signal at once. Bradykinin also survives, which adds vasodilation and the cough. Option b is incorrect because renin release from the kidney is the step aliskiren targets. Enzyme inhibitors leave that first stage untouched and act one reaction later, after angiotensin one has already formed. Option c is incorrect because receptor occupancy describes what the sartans do. Losartan and valsartan let the hormone form and then block it at the tissue, which is a different point in the sequence. Option d is incorrect because sodium transport in that segment is what thiazide diuretics interrupt. Salt handling changes as a downstream result of less aldosterone here, not because the drug touches the tubule itself.

Correct Answer: "I take St. John's wort for my low mood"

This herb induces the enzymes that clear warfarin, dropping the international normalised ratio and returning the client to clot risk. Every new product, including herbals and pain relievers, needs prescriber approval first. Option a is incorrect because an electric shaver avoids the nicks a blade leaves on anticoagulated skin. This habit belongs in the standard bleeding precaution list and shows the teaching took hold. Option b is incorrect because identification naming the drug lets emergency staff act quickly after trauma or collapse. Carrying that information, or wearing a medical alert bracelet, is exactly what is asked of these clients. Option c is incorrect because soft bristles and gentle mouth care protect gums that bleed easily during anticoagulation. Avoiding vigorous flossing and toothpicks matches published guidance, so no correction is needed here.

Correct Answer: Deficient fluid volume from excessive diuresis

Heat, ongoing diuresis, and limited intake have stripped intravascular volume. Dry membranes, tenting skin, concentrated urine, tachycardia, and confusion in an older adult together mark a dangerous fluid deficit needing prompt correction. Option a is incorrect because overload would show bounding pulses, crackles, distended neck veins, and sudden weight gain. Every sign here runs the other way, toward a shrinking circulating volume. Option b is incorrect because breathing was never described as labored and no adventitious sounds were reported. Oxygenation problems arise when fluid fills the alveoli, which is the opposite of this client's state. Option d is incorrect because no cramping was reported, and discomfort would rank below a circulatory threat anyway. Comfort needs matter, yet they never outrank perfusion when an older adult becomes confused and tachycardic.

Correct Answer: Losartan leaves bradykinin breakdown intact

Angiotensin receptor blockers work at the receptor and never touch the converting enzyme, so bradykinin is still degraded normally. Without that peptide piling up in the airway, the dry cough rarely appears. Option a is incorrect because renin itself is inhibited only by aliskiren, which sits at the top of the pathway. Sartans act far downstream at the receptor, so naming renin misplaces the site of action. Option b is incorrect because route of elimination has nothing to do with airway irritation. Lisinopril leaves unchanged in urine and still provokes coughing, which shows that clearance is not the deciding factor. Option c is incorrect because blocking the angiotensin receptor also shuts down aldosterone release, which is exactly why potassium climbs on these drugs. Both classes share that effect, so it cannot separate them.

Correct Answer: Thiazides lose effect when filtration falls

Thiazides act at the distal convoluted tubule and depend on adequate filtrate reaching that segment. Once filtration drops toward thirty milliliters per minute they stop working, while loop agents remain effective. Option b is incorrect because these drugs are not forbidden in kidney disease; they simply stop producing diuresis. Metolazone even keeps some activity and is added to a loop when diuretic resistance appears. Option c is incorrect because the distal symporter blockade wastes potassium rather than conserving it. Only aldosterone antagonists and sodium channel blockers push the level upward, and renal impairment does not reverse that. Option d is incorrect because urinary pH has no bearing on how this class works. Acetazolamide alkalinizes urine as part of its own mechanism, yet thiazide action rests entirely on sodium and chloride transport.

Correct Answer: Black tarry stools for two days

Digested blood turns stool black and tarry, which points to bleeding high in the gastrointestinal tract. On any anticoagulant that finding signals occult hemorrhage and needs evaluation before the hemoglobin falls further. Option a is incorrect because a bruise traced to a known bump is expected while clotting is slowed. Widespread unexplained bruising would concern the nurse, but a single explained mark is not an emergency. Option c is incorrect because heartburn after rich food reflects reflux rather than blood loss. Coffee ground emesis would change the picture entirely, yet plain indigestion alone does not demand an urgent call. Option d is incorrect because tiredness following strenuous outdoor labour is ordinary. Fatigue matters when it arrives with pallor, a racing pulse and a falling hematocrit, none of which appear in this report.

Correct Answer: Hold the next dose and notify the provider

A ratio far above the target band signals serious bleeding risk, and the gum bleeding confirms the drug is already too active. The nurse withholds the dose and reports the value promptly. Option b is incorrect because nurses do not adjust anticoagulant doses independently. Changing therapy without the prescriber exceeds the role and delays the assessment that this dangerously prolonged value demands right now. Option c is incorrect because waiting a week leaves the client unprotected while the clotting cascade stays suppressed. Recheck intervals of that length suit a stable result, not one this far outside the band. Option d is incorrect because bleeding gums count as a reportable sign in anyone on an oral anticoagulant. Calling it harmless dismisses an early warning that often precedes bleeding into the gut or brain.

Correct Answer: Warfarin needs several days before its full effect appears

Warfarin blocks new factor production but leaves circulating factors untouched, so protection builds over five to seven days. The injection covers that gap and stops once the ratio holds in range. Option a is incorrect because neither drug breaks down a clot that already exists. Both block further factor activity while the body's own plasmin slowly digests the thrombus, a job reserved for thrombolytics when speed matters. Option b is incorrect because overlapping therapy is deliberate and written into the order, not a response to a missed dose. Suggesting an error would alarm the family and misrepresent standard bridging practice. Option d is incorrect because the parenteral drug is withdrawn after at least five days once the international normalised ratio has stayed in range for a full day. It is a bridge, not lifelong therapy.

Correct Answer: Activate emergency response and secure the airway

Bradykinin driven swelling of the tongue and larynx can close the airway within minutes. Summoning the emergency team and preparing for airway management outranks every other concern in this presentation. Option a is incorrect because stopping future doses does nothing about the swelling already narrowing this client's throat. Documentation follows the rescue, and treating a closing airway as a paperwork matter risks a death. Option c is incorrect because an oral tablet cannot reach effect fast enough for tissue swelling that progresses over minutes. Watching and waiting wastes the narrow window in which the airway can still be secured. Option d is incorrect because a future appointment leaves a life threatening reaction untreated in the present. Angioedema is not a scheduling problem, and delay here allows obstruction to become complete.

Correct Answer: The exact time the client was last well

Standard intravenous thrombolysis is limited to roughly the first four and a half hours after the client was last known well. Without that time the team cannot decide whether the drug can be given. Option a is incorrect because elimination habits form part of a full history but carry no weight in the thrombolysis decision. Gathering them first would consume minutes that determine how much brain survives. Option b is incorrect because identifying the office physician helps with follow up rather than with an emergent treatment choice. The stroke team acts on timing and screening criteria, not on outpatient contact details. Option c is incorrect because cholesterol values guide long term prevention with a statin. They have no bearing on whether a clot dissolving drug is safe or still useful during this hour.

Correct Answer: Thyroid stimulating hormone and thyroxine

Amiodarone is heavily iodinated and blocks conversion of thyroxine, so hypothyroidism develops in roughly one in ten users. Cold intolerance, weight gain and sluggishness are the classic presenting complaints. Option a is incorrect because renal indices track drugs cleared by the kidney, and this one is metabolised hepatically. Nothing in the reported picture suggests failing kidneys or fluid retention from uremia. Option c is incorrect because clotting studies matter when this drug is combined with warfarin, whose effect it potentiates. Bleeding, not cold intolerance and slowing, would be the signal for that test. Option d is incorrect because pancreatic enzymes are ordered for epigastric pain, vomiting and suspected inflammation of that gland. Amiodarone injures lung, liver, thyroid, eye and skin instead.

Correct Answer: Swallow it whole with food and water

Potassium irritates gastric mucosa, so it goes down with a meal and a full glass of water. Extended release forms are swallowed intact, because crushing or chewing dumps the whole dose onto the stomach lining. Option a is incorrect because crushing an extended release tablet destroys the delayed delivery it was built for. The full amount hits the mucosa at once and makes the burning worse, not better. Option b is incorrect because an empty stomach leaves nothing to buffer the salt against the gastric lining. That timing is what produced the complaint the client is describing now. Option c is incorrect because chewing breaks the coating in the mouth and spreads a caustic salt across the mucosa. Oral irritation and an unpleasant taste follow, and absorption becomes unpredictable.

Correct Answer: Measure blood pressure lying and standing

Volume loss blunts the pressure response to standing, and the effect peaks within the first two hours after a dose. Comparing lying and standing readings identifies the client most likely to fall. Option a is incorrect because breath sounds track fluid overload over hours to days, not the sudden pressure drop that occurs on rising. Clear lungs would still leave this client at risk of collapsing. Option b is incorrect because checking dependent swelling evaluates whether the drug is working, which is useful but not urgent. It tells the nurse nothing about whether standing up will be safe right now. Option d is incorrect because sun sensitivity is a genuine thiazide problem addressed through sunscreen and protective clothing. A rash on the forearms has no bearing on the immediate danger of a fall.

Correct Answer: Stop the nurse and clarify the route

Concentrated potassium given by push causes cardiac arrest, and there is no bedside exception to that rule. The drug is diluted and infused slowly on a pump, so the route is stopped and clarified. Option b is incorrect because supervising a lethal route does not make it safe. Slowing the plunger cannot protect the myocardium from a bolus of concentrated electrolyte reaching it in seconds. Option c is incorrect because dilution inside a syringe still delivers the whole amount at once. Safe replacement means a large volume bag, an infusion pump, and a rate set by policy. Option d is incorrect because flushing the line addresses patency and compatibility, which are not the problem. The hazard lies in pushing this electrolyte at all, regardless of how the line is prepared.

Correct Answer: Tolerance developed from uninterrupted nitrate exposure

Vascular smooth muscle stops responding when nitrate levels never fall, and effectiveness can be lost within a day of continuous therapy. A daily drug free period restores receptor responsiveness. Option a is incorrect because complete occlusion produces unrelenting pain, ST changes and rising troponin rather than a gradual fading of preventive benefit. This client still gets relief when dosing pauses. Option b is incorrect because an excessive amount would announce itself through pounding headache, dizziness and low blood pressure. Loss of effect points toward habituation of the vessels, not toward too much drug. Option c is incorrect because adhesive sensitivity shows as local redness, itching and blistering under the film. Skin reactions do not weaken the systemic vasodilation that prevents anginal episodes during exertion.

Correct Answer: Activated partial thromboplastin time

Heparin amplifies antithrombin activity against thrombin and factor Xa, which lengthens the intrinsic pathway measurement. The activated partial thromboplastin time is kept at roughly one and one half to two and one half times the control value. Option b is incorrect because prothrombin time and the international normalised ratio track the extrinsic pathway and factor seven, the pathway warfarin suppresses. Those values barely move on a heparin drip and cannot guide titration. Option c is incorrect because a blood count reports cell numbers rather than clotting speed. Platelets within that panel matter for spotting heparin induced thrombocytopenia, yet they say nothing about whether anticoagulation is adequate. Option d is incorrect because renal chemistry values describe kidney clearance, which guides dosing of enoxaparin and the direct oral agents. Unfractionated heparin is titrated by clotting studies, not by these numbers.

Correct Answer: Swelling of both ankles and feet

Dihydropyridine agents dilate arterioles far more than veins, so capillary pressure rises and fluid collects in the ankles. The swelling is a drug effect rather than volume overload, and diuretics relieve it poorly. Option a is incorrect because this agent works on vessels and leaves the conduction system alone. Reflex quickening of the pulse, not slowing, is what follows the drop in vascular resistance. Option b is incorrect because tinnitus points toward a loop diuretic given too quickly, not toward a calcium channel blocker. Hearing is not a monitoring parameter for this class. Option d is incorrect because urine color changes and flank pain suggest a renal or urinary problem needing its own workup. Nothing about arteriolar dilation produces that pattern of complaint.

Correct Answer: Hold the drug and obtain cardiac monitoring

This level with paresthesias and nausea signals hyperkalemia that can progress to peaked T waves, widened complexes, and arrest. Stopping the drug and placing the client on a monitor protects the heart. Option a is incorrect because bananas are among the richest potassium sources available. Feeding more of the mineral to a client whose level already sits above the reference range would deepen the emergency. Option c is incorrect because extra fluid and walking address dehydration and stiffness, not a potassium excess. Neither measure moves the ion out of the blood, and walking a weak client invites a fall. Option d is incorrect because recording a critical value without stopping the drug allows the level to climb further. Continuing an aldosterone antagonist during hyperkalemia is exactly the situation the monitoring schedule exists to catch.

Correct Answer: A gain of three pounds in one day

A rapid gain means fluid is being retained faster than the drug can remove it. Two to three pounds overnight, or five pounds across a week, signals worsening failure and needs prompt reporting. Option a is incorrect because a single pound shed over four weeks falls within ordinary variation. Slow changes of that size carry no fluid meaning and would flood the clinic with meaningless calls. Option b is incorrect because food and drink in the stomach shift the reading without reflecting body fluid. Weighing under identical conditions each morning removes that noise, which is exactly why the routine was taught. Option c is incorrect because gradual loss of retained fluid is the therapeutic response everyone wants. Edema shrinks, breathing eases, and the number on the scale drifts down, so nothing there warrants a telephone call.

Correct Answer: Digoxin immune Fab given intravenously

Digoxin immune Fab is made of antibody fragments that bind the drug and strip it off tissue sites. It is reserved for life threatening dysrhythmia, high grade block, or a climbing potassium during acute toxicity. Option a is incorrect because protamine reverses heparin by binding it directly in the bloodstream. It has no affinity for a cardiac glycoside and would leave this rhythm disturbance untouched. Option b is incorrect because flumazenil belongs to benzodiazepine overdose, where it competes at the same receptor to restore alertness. Sedation is not the emergency described in this scenario. Option d is incorrect because acetylcysteine replenishes glutathione after an acetaminophen ingestion and protects the liver. Neither the heart rhythm nor the potassium in this client would respond to it.